Depression prevention for pregnant women and new mothers – new recommendations

At present all new mothers are screened for symptoms of depression and help is provided to those who need care. The U.S. Preventive Services Task Force now has urged doctors to screen pregnant women for risks of depression and provide adequate counselling and support to prevent the onset of depression after delivery. The report was published in the Journal of the American Medical Association this week.

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According to the U.S. Preventive Services Task Force one in seven women suffer from perinatal depression which means depression during pregnancy or after childbirth. Postpartum depression or baby blues, as it is commonly called, can affect women deeply causing depressive symptoms, anxiety, intense sadness, lack of energy, lack of ability to bond or care for the new born etc. In severe conditions it can also lead to suicidal ideation, self harm or harm to the baby. This week the Task force thus urged doctors to identify pregnant women who are at risk of depression and treat them before it worsens.

The Task force outlines that for perinatal depression (depression during pregnancy or within a year of childbirth), two kinds of counselling could be suggested. One of these is Cognitive behavioral therapy or CBT. This helps patients to overcome their negative thoughts and manage them effectively. The other form of therapy is interpersonal therapy that targets problems with relationships which could be causing the depression. Both of these counselling could be done one-on-one or in groups. To come up with the efficacy of counselling for these women the Task force looked at 50 studies and found that a variety of methods were applied to treat perinatal depression. This included antidepressant medication, omega 3 fatty acids, physical activity, patient education and counselling.

Karina Davidson, member of the team that drafted the recommendation said, “We can prevent this devastating illness and it's about time that we did.” She said that the problems compound for mothers with depression with low birth weight, failure to thrive and premature birth of the babies.

Some of the identifiable risk factors that have been outlined by the Task force for the health care providers to detect risk of depression include;

Previous history of depression

Depression in the family

Unwanted or unplanned pregnancy

Sexual or physical abuse in the past or present

Teenage pregnancies

Pregnant women from low income groups

Along with these new recommendations was an editorial by Dr. Marlene Freeman, a psychiatrist from Harvard Medical School working at Massachusetts General Hospital, that appeared in the same issue. She says that it is difficult for many women to get access to specialists. Experts have suggested counselling via smartphones for women who are detected to be at risk. The editorial says said that when detected, healthcare providers need to act quickly before the actual symptoms appear. She added however that this move could “improve many lives” and could lead to a “trajectory of better outcomes for a lifetime for both mother and child”. She said easy detection tools for doctors could come up from future research to detect perinatal depression early.

The earlier recommendation from the Task force in 2016 had suggested screening for depression among all adults including pregnant women. This year perinatal depression is a specific focus say experts. “We actually have evidence now that if you find women who are not currently depressed but who are at risk for becoming depressed during pregnancy or within a year after childbirth behavioral counseling can help them prevent getting this disease,” said Davidson.

Ananya is a doctor by profession, lecturer by vocation and a medical writer by passion. She specialized in Clinical Pharmacology after her bachelor's (MBBS). For her, health communication is not just writing complicated reviews for professionals but making medical knowledge understandable and available to the general public as well.

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